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HomeMy WebLinkAbout2983-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEF~TIFII]ATE DF ODDUPANDY No. Z. ~,.9.ql.. .... Date .... ilC~;ol'm.x, 3¢ ............ , 19.. 67 THIS CERTIFIES that the building located at .... i~eut:a .27i~ ............ Street Map No ..... ~,'77X Block No... ~ ...... Lot No..XJCS; ......... ~latfCl~.~.tl¢Ig ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~:e~l:u~ir. I.. , 19.66 pursuant to which Building Permit No... 2-9~t3. Z dated ........ Fel;~uaa:~r..2 .... ,19.66, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . addif~:~on. ,,o .one .~aff~3,Z. rt~s&d, nca ................................ The certificate is issued to ..... ~iSa .1)r~-'&s .;B~e.v.e. ,.-..r~,me=. ...................... (owner, lessee or tmmnt) of the aforesaid building. Suffolk County Department of Health Approval ...... tq/tt ......................... / Building InspeCt'or BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ' , · COMPLETION OF THE WORK AUTHORIZED) N? 2983 Z Date,. .............. Permission is hereby granted to: · .......... .......... ....... ;,:......-~ ...... to .,~u&~...~.n..~,~¢.~o~..~..~n.-.e~-~g..~l:~ng ...... t ................................... . ......... :,. at premises located at ....~-/~.....~d.te.-:~..-(,~.~-~ ................................................... ,4~.~e~v..~:~, ........................................................................... pursuant to application dated ........................ ~ ....... .~. .................. 19(~,.., and approved by the Building Inspector Fee $ .~.~ 0.0 .............. ...... ~..~.¢.,..Z ..................................... ,~ ......................... Building Inspector{ ~OENI NO. 1 Examined ..... : ..... il ......... , 19. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .............................. Disapproved a/c ................ ~,,,:.)~ ........... .::~,,~......:~:~. ........ ~Z~ .................... Application No ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT ...... .......... . INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relo¢ionship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applica.nt. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA,DE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations for the construction of buildings additions, alterations, or for removal or demolition, as herein described. The appBcant agrees to comply with oil applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporotio6) ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p~,umber or builder. ................................................. ...~..~.~.£.1~,./~...L........~..o.. ~.:.m.. ~,.~...~....-r...0..~-, ........................................................... Name of owner of premises ..... I..V~.. ~ ~.. ~ ¢~ ~. L..~.........~...6,,....~....~..~, ................................................................. If appli,c, ant is a. corporate, signature of duly authorized officer. ....... .... (Name and title of corCdrate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ................... ............................ ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..~ t~,~ .C~.~.~ .-~.. ff~.h41L-'~(. ...~.. ~_~..~V~b~ i~C~__ ... b. Intended use and occupancy ....... .~..J...~...~ .~..~.. ...... ..~..~.]'~.!..~..~.........~....~......~...I...~...~...~....~.(~ ............... 3. Nature of work (check which applicable): New Building .................... Addition ..... ~/~ ..... Alteration .................. Repair .................. Removal/, .................. Demolition .................. Other Work (Describe) .................. 4. Est mated Cost 'e' ..~ .~. ~.(~. ~ e~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... ~ ................... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupa,ncy, specify nature .and extent of each type of use ................... ~ ................ 7. D,mens,ons of ex,st,rig structures if any: Front ...... .~..~. ........ Rear ..~'~.(~. .............. Depth ....~.~ ............. Height ....... ~-. ................. Number of Stories ............... /...~../~ .......................................................................... Dimensions of same structure with alterations or additions Front .... ..~...~o.' .... Rear ]..C].-~. Depth ....... .~. ..................... Height ......... ,~.f~ ................. Number of Stories ..... I...~ ................... 8. Dimensions of entire new construction: Front .I.J .......................... Rear ..J.]....Z..2, ............. Depth .............................. Height .....]./....-. ................ Number of Stories ........ ~ .................... 9. Size of lot: Front .......~.~ ................ Rear .......... 5.0 ................. Depth ....... L.~.(~. ............. 10. Date of Purchase .......................................................... No,me of Former Owner ~..~...; .............................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction viol.ate any zoning~law, ordinance or regulation? I'~xl ..o. . Name of Architect .............L.~.. .......... -~. ....................... Address .... ................................................ Phone No. PLOT DIAGRAM Loca,te clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. FeTe ,, ~'7A STATE OF NEW YORK, ) COUNW ....... )s.s. ~ ~.~ ~ ~.., ...... .~.~.. bein~ du~v sworn, deposes ond says that he is the opplicont (~ome of individual s~ninfl opplicotion) obove homed. He is tho ................................ ~...~..~.~.~.~ ................................................................ (Controctor~ ~ent, corporote officer, otc.) of s~ir~ owner or owners, ond is duly ~uthoHzed to perform or hove performed tho soid work ond to moke ond file this ,ppficafion~ Ihot ~ff sI*temenfs contoined, in th~s oppfic~fion aro truo to ~ho Bost of his knowlodoe ~nd be~ef~ ~nd that tho work will be performed in the m~nner set forth in tho ~p~licotion filed thorewith. Sworn to bofore me this ...........................